Residential aged care facilities (RACFs) provide full-time, permanent care for older adults who are no longer able to live at home independently. In these facilities, new technology such as tablets, virtual reality, and social robots are increasingly being deployed with the aim of providing engaging and fun activities for residents. Although HCI research has examined the design and use of technology in aged care, there is limited understanding of the role staff members play in its deployment in RACFs. To address this gap, we interviewed five workers from one Australian RACF about new technology use within their facility. We found that its implementation was part of a complex, decision-making hierarchy in which issues such as marketing potential and staff members' roles and capacity, created tensions about the use of new technology. Drawing on our findings, we identify issues HCI researchers should consider when introducing new technology in this complex environment.

This report describes the major changes that have taken place in working conditions in care for older people from 2005 to 2015. Comparisons between the situation in Finland and other Nordic countries are also included. The report is based on the second wave of a Nordic questionnaire study among unionised care workers in Finland, Sweden, Norway and Denmark.

This national study conducted in Aotearoa New Zealand was a two-arm mixed-method cross-sectional study using a concurrent triangulation design. The quantitative arm includes the results of 433 staff surveys related to knowledge, attitude, behaviours and beliefs about sexuality, intimacy, and ageing. The qualitative arm includes interviews with 75 participants including staff, residents, and family members. The study addresses issues of decision-making around consent and sexuality, and includes issues related to dementia, transition to residential care, loneliness, physical structures and furnishings of care facilities, religion and ethnicity, sexual and gender diversity, sex work, and education.  Facilities will want to establish policies about sexuality and intimacy and regularly communicate those policies and practices to staff, residents and family members. Facilities may also wish to consider educational events about gender and sexual diversity for residents and family members as well as staff. See the report online at https://mro.massey.ac.nz/handle/10179/15720

Hintergrund:
Implementationsforschung rückt immer stärker in den Fokus der Gesundheitsförderungsforschung. Sie zielt darauf, innovative und wirksame Gesundheitsprogramme der Praxis zugänglich zu machen und deren effektive Umsetzung sicherzustellen. Für das Setting der stationären Altenbetreuung wurden bislang kaum Studien durchgeführt, die aufzeigen, welche Faktoren den Implementationsprozess von Gesundheitsförderungsprogrammen begünstigen oder behindern.

Methode:
Durch eine qualitative Studie wurde der Implementationsprozess eines Programms zur Mobilitätsförderung für alte Menschen in drei Wiener Pensionisten-Wohnhäusern untersucht. Dabei wurden 12 teilstrukturierte Interviews mit Personen geführt,
die bei der Implementation in einer leitenden oder operativen Verantwortung standen.

Ergebnisse:
Die strategische Verankerung des Programms und die damit verbundene starke Wahrnehmung der Führungsrolle der
leitenden Mitarbeiter/innen haben sich als förderliche Faktoren erwiesen. Des Weiteren war das Programm anschlussfähig an das Rollenverständnis und die Expertise der für die Umsetzung verantwortlichen Berufsgruppe
und bot dieser Möglichkeiten zur beruflichen Weiterentwicklung sowie Spielräume für Autonomie.
Hinderlich war ein zeitgleicher organisationaler
Umstrukturierungsprozess, im Zuge dessen die Implementation des Programms von allen befragten Personen als zusätzliche Belastung wahrgenommen wurde.
Außerdem fehlten Strukturen für Austausch und Kooperationen.

Schlussfolgerung:
Neben der strategischen Verankerung benötigt eine erfolgreiche Implementierung eines Mobilitätsprogramms ein operatives Management, das Koordinationsaufgaben wahrnimmt und notwendige Unterstützungsstrukturen (für Austausch und Kooperation) schafft.

Link:
http://link.springer.com/article/10.1007%2Fs11553-014-0463-0#page-1

The use of physical restraint in residential aged care (RAC) is relatively common [1]. Existing research suggests that the proportion of residents physically restrained in RAC facilities ranges from 12% to 47% [2]. The last two decades have seen much research discussing both the potential benefits and adverse consequences of physical restraint [3]. While at a global level, there are distinctive factors that determine both the prevalence and justification for employing physical restraint on a case by case basis rather than an umbrella explanation [4], the prevalence of physical restraint use in RAC is concerning. If knowledge about the negative impact on quality of care and quality of life could be presumed to decrease the use of physical restraint in RAC, then additional factors could also be presumed to be simultaneously (and strongly) promoting the use of physical restraint. In this paper, in the moment affective processes (e.g., emotions, negative attitudes) are suggested as one such likely factor, potentially overriding knowledge-based interventions and thus maintaining the use of physical restraint. Specifically, negative attitudes towards residents residing in RAC may exist in many populations, and these, in addition to the unique environment associated with working in RAC (including high levels of one on one care, frailty and decrease mobility), perhaps promotes behaviour that is driven by affect, rather than knowledge. Multiple studies reveal that physical restraint harms residents [2]. In particular, serious injury and mortality are often directly related to both proper and improper use (selection and application) of physical restraint on residents [1], and physical restraint is likewise associated with reduced psychological well-being, and mobility [2]. Further, residents who are managed via physical restraint exhibit rapid cognitive decline compared to those who are not restrained [2, 5]. Despite this evidence, physical restraint is frequently referenced as a protective measure [6]. For example, it is argued that physical restraint reduces the risk of personal injury to residents and employees [2], controls wandering, and facilitates medical treatment [7, 8]. However, the literature suggests that such justifications are not evidence-based and in fact are not supported by the data [8, 9].

Objective: To evaluate the effects of a laughter yoga activities (LY) program for older people living in residential aged care homes (RACHs). Methods: A 6-week LY program was implemented at three RACHs with twenty-eight residents. A pre–post design was used to measure positive and negative affect, happiness, blood pressure and pulse. Results: Post-session mean scores for positive mood, and happiness were significantly higher than pre-session scores in weeks 1, 3 and 6, and the post-session mean negative mood scores were significantly lower than pre-session scores in weeks 3 and 6. Post-session readings for mean systolic blood pressure were significantly lower than pre-session readings in weeks 1 and 6. Conclusion: This study demonstrates the potential for using LY to improve mood and lower blood pressure of older people living in RACHs. Policy Impact: Laughter yoga should be considered by Management and Lifestyle coordinators/activities staff in residential aged care homes to be included in their regular activities program for residents. By incorporating LY into the culture of the RACHs, a sense of fun and happiness will be achieved for both residents and staff. Practice Impact: Laughter yoga improves happiness and positive mood and decreases negative mood in older people living in residential aged care homes, and has the potential to lower blood pressure. It also provides opportunities for residents to exercise, have fun and enjoy themselves, so should be incorporated into lifestyle programs.

The World Health Organisation suggests that younger onset dementia (YOD) requires specific consideration as it often affects people who are physically fit, socially more active, employed with dependent children and whose behaviour may be more challenging for care givers. Currently, there are no specialised services for people with YOD in New Zealand and people with more advanced YOD requiring care outside their home are placed in aged care facilities.

The paper explores the design ideas that provide therapeutic resources or remove barriers to quality of life and wellbeing.  Themes of memory, autonomy and therapy were found to have most relevance to well-being. Design can provide sensory stimulation and opportunity for greater physical, social and community engagement and contain, accumulate and project memories in a way which stimulate and inspire reminiscing and imagining. Institutional aged care facilities do not provide these cues for those with YOD.

The quality of life of people with YOD and their family care givers can be seriously compromised due to a lack of specialised facilities and services. The default to services designed for the frail and elderly is inappropriate and unsatisfactory.

Following the trend in most developed countries, in Austria the oldest old are the fastest growing population group. Among this group, there is a high prevalence of multimorbidity, functional impairment, dementia, and psychiatric conditions. While health promotion (HP) has been considered relevant in coping with the challenges of an aging population, it has so far been viewed as a foreign concept in relation to the oldest old, especially those living in residential aged care (RAC) facilities. Although there is an acknowledgement that HP should be integrated into routine nursing, there has been little research on how professionals working in RAC interpret and implement HP. In this study, thirteen semi-structured interviews were carried out with professionals from four major Austrian RAC providers. Data was analyzed using thematic analysis. The findings show that, typically, professionals understand HP as a concept that is oriented towards maintaining potentials and resources, thereby promoting self-determination, autonomy, and social integration, including frail and functionally impaired elderly residents. However, data analysis also revealed a gap between the conceptual understanding and positive attitudes towards HP and its implementation in practice. Implementation of HP seems to occur in isolated cases, related to specific health issues. It seems that more complex HP approaches, especially the ‘settings approach’, are hardly practiced. To implement more comprehensive and systematic HP in Austrian RAC, support from external HP agencies as well as changes in financial incentives are needed.

According to all available data, Spain has been one of the European countries most seriously hit by the pandemic, experiencing dismaying figures regarding the number of deaths in care homes for older people. Between March and August 2020, at least half of the deceased due to the pandemic resided in care homes.
Although it is premature to establish the relative weight that the management of the care homes sector may have had in the death-toll rate vis-à-vis other factors,
everything seems to indicate that had there been preventive measures and emergency plans in place that could have prevented the entry of the virus and its transmission within the nursing homes (or at least reduced its intensity), the number of deaths may
have been sensibly smaller. To better understand what happened in these centres, and to facilitate policy learning, this study identifies the difficulties faced by institutional actors and nursing homes’ managers between January and August 2020.

Background
People with dementia have unique palliative and end-of-life needs. However, access to quality palliative and end-of-life care for people with dementia living in nursing homes is often suboptimal. There is a recognised need for nursing home staff training in dementia-specific palliative care  to equip them with knowledge and skills to deliver high quality care.

Objective
The primary aim was to evaluate the effectiveness of a simulation training intervention (IMPETUS-D) aimed at nursing home staff on reducing unplanned transfers to hospital and/or deaths in hospital among residents living with dementia.

Design
Cluster randomised controlled trial of nursing homes with process evaluation conducted alongside.

Subjects & setting
1304 people with dementia living in 24 nursing homes (12 intervention/12 control) in three Australian cities, their families and direct care staff.

Methods
Randomisation was conducted at the level of the nursing home (cluster). The allocation sequence was generated by an independent statistician using a computer-generated allocation sequence.

Staff from intervention nursing homes had access to the IMPETUS-D training intervention, and staff from control nursing homes had access to usual training opportunities. The predicted primary outcome measure was a 20% reduction in the proportion of people with dementia who had an unplanned transfer to hospital and/or death in hospital at 6-months follow-up in the intervention nursing homes compared to the control nursing homes.

Results
At 6-months follow-up, 128 (21.1%) people with dementia from the intervention group had an unplanned transfer or death in hospital compared to 132 (19.0%) residents from the control group; odds ratio 1.14 (95% CI, 0.82-1.59). There were suboptimal levels of staff participation in the training intervention and several barriers to participation identified.

Conclusion
This study of a dementia-specific palliative care staff training intervention found no difference in the proportion of residents with dementia who had an unplanned hospital transfer. Implementation of the intervention was challenging and likely did not achieve adequate staff coverage to improve staff practice or resident outcomes.